A patient presents with severe anal pain, lasting hours after each bowel movement. She notices some intermittent bleeding with defecation. She comes to the office with the presumed diagnosis of hemorrhoids. Are her symptoms consistent with hemorrhoidal disease, or does she have another disorder? Benign anorectal disorders are common and increasing in incidence. The decreasing intake in dietary fiber over the 20th century and into the 21st has contributed to a steady rise in preventable anorectal disorders.
An anal fissure is a common and often painful problem caused by a small tear or ulcer open sore in the lining of the anus back passage. This can cause bleeding, local itching and pain with a bowel movement, which can be severe. When someone has an anal fissure the first treatments can include a high-fibre diet, laxatives and applying anaesthetic ointments to the affected area. Anal fissures usually heal within a few weeks but those that have not healed after 4—6 weeks are called chronic fissures. If someone has a chronic fissure, it is thought that the reason it has not healed is that the ring muscle sphincter that goes around the anus back passage has become so tense that the flow of blood to the lining of the anus is reduced.
Solitary rectal ulcer syndrome is a rare disorder that involves straining during defecation, a sense of incomplete evacuation, and sometimes passage of blood and mucus by rectum. It is probably caused by localized ischemic injury or prolapse of the distal rectal mucosa. Diagnosis is clinical with confirmation by flexible sigmoidoscopy and biopsy. Treatment is a bowel regimen for mild cases, but surgery is sometimes needed if rectal prolapse is the cause. See also Evaluation of Anorectal Disorders.